Original presentation took place at the 2016 American Speech Language Hearing Association convention in Philadelphia, Pennsylvania on Saturday, November 19, 2017. Alex Koller and Amanda Soper worked together at a special education school in Washington, D.C. as a Speech Language Pathologist and Assistive Technology Specialist. The presentation describes the issues related to providing communication systems to older students with complex communication needs, why these students may stop communicating, why speech language pathologists are not prepared for these students' needs, and how one school established a robust augmentative and alternative communication (AAC) program.

1. IT’S NOT TOO LATE:
AAC FOR OLDER
STUDENTS
Amanda Soper MS CCC-SLP and Alex Koller
MA CCC-SLP
Koller & Soper 2016
ASHA Convention: November 19, 2016

2. Disclosure
We have no relevant financial or nonfinancial relationship(s)
within the products or services described, reviewed,
evaluated or compared in this presentation.
Koller & Soper 2016

3. Learning Objectives
1. Understand what complex communication needs are
2. Identify two reasons older students are denied access to AAC
3. Identify resources for SLPs to increase competence in AAC
4. Define a practical plan for implementing AAC school or district wide
Koller & Soper 2016

4. What does it mean to say a student has Complex
Communication Needs?
Communication Disorder
• due to motor, language, cognitive, and/or sensory-perceptual impairments
• Heterogeneous group of individuals
• Acquired and developmental
• Communication is impacted
• Expressive and Receptive language impact
• Speech impact
• Impacts access to environment and a range of communication partners
• Limits opportunities for communication
 (Light & Drager 2007)
Koller & Soper 2016

5. How do students with CCN communicate?
 Nonsymbolic communication includes body gestures, intonation of
verbalizations, facial expressions, and changes in body posture and level of
body excitation (Beukelman & Mirenda, 1998).
Behaviors and Unconventional Communication
 Body movements- leaning away or towards an object
 Facial expressions, early sounds, changes in postures
 Unconventional communication
 Tugging on people, grabbing at objects, pushing away
Koller & Soper 2016

6. How do students with CCN become less
communicative over time?
Student never
learns to
communicate in
a conventional
way
Students use
unconventional
communication
Caregivers do not
validate
communication
Caregivers
begin to
anticipate
the student’s
needs
Lack of
communication
opportunities
Koller & Soper 2016

7. Sunny
Picture removed for privacy
Koller & Soper 2016

8. Sunny’s Story
 18 year old young woman with Rett Syndrome
 Came to our school in 2013
 Previous Cog Testing Results
 Initial IEP created with the following goals:

9. Previous IEP
Present Levels of Performance: [...] Sunny requires hand over hand
assistance for all classroom participation. She does not use eye gaze
consistently to select or respond.
Goals:
Math: Sunny will remain on task for at least 5 minutes and will move her head from side to side to
activate the VOD to participate in math.
Reading: Sunny will remain alert for at least 5 minutes and will move her head from side to side to
activate the VOD to participate in reading.
Communication: Sonsyrae will use an eye gaze board to identify yes and no.
Speech Services: 30 minutes per month
https://talksense.weebly.com/feature-101-ideas-for-a-bigmack.html
Koller & Soper 2016

10. CURRENT IEP
Present Levels of Performance: [...] Sunny requires hand over hand
assistance for all classroom participation. She does not use eye gaze
consistently to select or respond.
Goals:
Math: Sonsyrae will identify numbers 1-5 and count sets with 80% accuracy in 5 opportunities.
Reading: Sonsyrae will participate in shared reading using at least two communication functions (e.g.
labeling, making comments, giving directions, and asking questions) using her AAC system (e.g. manual
eye gaze board, high tech eye gaze SGD) 5 times in a session.
Communication: Sonny will communicate for 5 language functions (i.e., requesting, refusal, commenting,
asking questions, gaining attention) measured weekly.
Speech Services: 3 hours per month
Koller & Soper 2016

11. Better late than never…but why not sooner?
 Communication Opportunities are Key!
• Communication systems are often abandoned if communication partners can
understand the user without the system OR if partners do not provide opportunities
to communicate (Johnson, Inglebret, Jones, & Ray. 2006).
• “Families in this investigation appeared to have such a sophisticated understanding
of their children’s [nonsymbolic communication] that the use of the device was
unnecessary in typical communication exchanges” (Bailey, et. al. 2006).
• Inappropriate device prescriptions and inadequate caregiver training (Beukelman &
Mirenda, 2005)
Koller & Soper 2016

12. Why does this happen to older students?
Low formal
cognitive and
language
assessment
results.
Professionals
believing low
cognitive scores =
low language
ability.
Students are
being taught at
the level they
tested at (low)
Students are not
“progressing”
Students are not
given necessary
services to learn to
communicate
Koller & Soper 2016

13. How can SLPs help break the cycle?
 “Speech-language pathologists (SLPs) work to prevent, assess, diagnose, and treat
speech, language, social communication, cognitive-communication, and swallowing
disorders in children and adults.”
 “Provide augmentative and alternative communication (AAC) systems for individuals with
severe expressive and/or language comprehension disorders, such as autism spectrum
disorder or progressive neurological disorders.”
 (American Speech-Language-Hearing Association, 2010).
Koller & Soper 2016

14. Undermining Ourselves: SLP
Assumptions about Student Progress
 Student progress is related to goals and expectations set
 When not making progress SLPs may assume it is the student rather than
the communication system or its implementations
 Students are assumed to have “plateaued”
 “The individual who uses an augmentative or alternative communication system has
achieved optimal communication across environments and communication partners.”
(ASHA, 2004).
 SLPs may assumed systems have previously been tried and failed
 lack of progress might indicate that the intervention is a poor fit” (ASHA 2004)
Koller & Soper 2016

15. SLPs are unprepared for students with
Complex Communication Needs
• 81-93% of practicing SLPs report that they did not complete a single course focused on
the needs of children with CCN (Costigan & Light, 2010)
• According to national surveys of graduate programs (Costigan & Light, 2010; Ratcliff, Koul,
& Lloyd, 2008)
• 18-35% of preservice programs do not offer any coursework at all in AAC
• Of those that do, many do so on a limited basis
• i.e. 1-4 hours of AAC content infused in other courses
• Only a small percentage of programs offer full courses in AAC
• Approximately half of these are not required courses
Koller & Soper 2016

16. How can SLP’s gain knowledge after graduate
school?
Koller & Soper 2016
 Dynamic Learning Maps
 Angelman Communication Training Series
 Pittsburgh AAC Language Seminar Series
 Specific Trainings
 LAMP
 PODD
 Specific Professional Development Conferences
 ATIA
 Closing the Gap
 ISAAC
 State Conferences
 TalkingAAC Conference(Michigan)
 AAC in the Desert (Arizona)
 Resources- device lending libraries

17. Dynamic learning maps
Koller & Soper 2016
 Beginning Communicators
 DLM™ Core Vocabulary and Communication
 Principles of Instruction in English Language Arts
 Speaking and Listening
 Who are Students with Significant Cognitive Disabilities?
http://dynamiclearningmaps.org/

18. Pittsburgh AAC Language Seminar
Series
Koller & Soper 2016http://www.minspeak.com/PittsburghAACLanguageSeminarSeries.html#.WgoDztKnGUk

19. Specific Trainings
 Device/ Strategy Specific – LAMP/ PODD/ UNITY courses
 PRC offers general AAC strategy courses with great suggestions
 Professional Conferences
 ATIA
 Closing the Gap
 ISAAC
 State Conferences – AAC in the Desert (Arizona), Talking AAC Conference (Michigan)
Koller & Soper 2016

20. How to increase communication in
older students
LONG TERM GOAL: Have skilled
communication partners to encourage
communication.
SHORT TERM GOALS:
1. Increase opportunities for communication.
2. Understand how students communicate
especially with unconventional means.
3. Respond appropriately to students’
communication attempts.
Koller & Soper 2016

21. Increase opportunities for communication
Strategy Example
Sabotage 1. Item in sight but out of reach
2. Items in clear boxes, need help to get to them
3. Give student the wrong item
Wait time 1. While reading a book, pause after a page to see if the student has any
reaction
2. While playing a game, “forget” to take your turn or skip the student “by
accident”
Use motivating
items/ actions/
activities
1. Send home a reinforcement inventory
2. Try a variety of activities until you find ones that work.
3. When you find ones that work, consider why it’s successful.
Koller & Soper 2016

22. Understand how students communicate
Strategy Example
Body Movements 1. Leaning forward or backwards from the item/ person
2. Reaching for items/ people
3. Others – rocking, bouncing, walking away, etc.
Vocalizations 1. Crying
2. Cooing
3. Specific vocalizations/ intonations
4. Approximations
Facial Expressions 1. Smiling
2. Grimacing/ Frowning
3. Closing eyes
4. Other: wiggle eyebrows, mouth movement
Koller & Soper 2016

23. Respond Appropriately to Communication
Strategy Example
Shape
nonconventional
1. Model and teach AAC system to communicate (i.e. when student
reaches for item, model “want that.”
Shape behaviors 1. Practice replacement communication outside of the behavior
2. Provide opportunity to use communication upon seeing pre-curser
behaviors
Shape verbal
approximations
1. Model on AAC system for unintelligible students
Koller & Soper 2016

24. How to Impement AAC within your
School or District
1. Ensure all SLPs have knowledge about the importantance of core vocabulary and its role
in AAC
2. Use standard core vocabulary AAC boards
3. Make sure all students have an AAC system in place (low tech allows this to happen
quickly)
4. Begin evaluations for students to obtain high tech speech generating devices
Koller & Soper 2016https://store.prentrom.com/the-pixon-sup-tm-sup-project-kit

25. How can SLPs gain access to standard
Core Vocabulary Boards
1. Pixon Project Kit
2. Project Core - 36 Location Core Boards
Koller & Soper 2016
https://store.prentrom.com/the-pixon-sup-tm-sup-project-kit

26. Getting AAC Systems in Place School Wide
LONG TERM GOAL: Provide the student with a device he/she can grow
into, utilizing a robust language system.
Barriers: funding, evaluation reports, device trials, budgets
SHORT TERM GOALS: Provide the student with a system that he/ she
can use now.
1. Often look at no-tech and midtech
2. Provide systems with core vocabulary
3. Resources: Pixon Project Kit & Project Core
Koller & Soper 2016

27. Getting AAC Systems in Place School Wide
 LONG TERM GOAL: trained communication partners, comfortable with
and proficient at modeling AAC
 SHORT TERM GOALS:
 Understanding of why AAC is needed
 Basic modeling skills
 Recognizing that the system needs to be with the student at all
times
Koller & Soper 2016

28. How did we do this?
• Reach out to device representatives in the area for equipment
• Provide SLPs/the school with standard CORE/Fringe vocab
boards
• Used money in budget for mid-tech devices for students who
NEEDED voice-output
• Found grant money to obtain high tech devices for trials and
evaluations
• Provided trainings for different groups: teachers, therapists,
paraprofessionals, parents, etc.
• Looked for students who were likely to have quick success to
encourage buy-in from administrators and staff
Koller & Soper 2016

29. Why consider insurance for older students?
Students leave the school system without a
voice
Insurance allows them to take the high tech
communication systems with them
It is important to select a language system that
allows for growth
Koller & Soper 2016

30. Case Studies
Removed for privacy

31. Take Away Points
 It is imperative that SLPs conducting AAC evaluations or treating
students with complex communication needs gain additional
knowledge
 Need to continue to push ASHA towards AAC specialization
 It is not too late for older students!
 Always presume competence from students
 When introducing systems to new classrooms, schools, districts:
need to get other team members on board by encouraging them to
participate and interact with system and students
Koller & Soper 2016

32. References
 Light, J., & Drager, K. (2007). AAC technologies for young children with complex communication needs: State of the science and future
research directions. Augmentative and alternative communication, 23(3), 204-216.
 Johnson, J. M., Inglebret, E., Jones, C., & Ray, J. (2006). Perspectives of speech language pathologists regarding success versus
abandonment of AAC. Augmentative and Alternative Communication, 22(2), 85-99.
 Beukelman, D. R., & Mirenda, P. (1998). Augmentative and alternative communication: Management of severe communication disorders in
children and adults (2nd ed.). Baltimore: Brookes.
 Bailey, R. L., Parette, H. P., Stoner, J. B., Angell, M. E., & Carroll, K. (2006). Family members' perceptions of augmentative and alternative
communication device use. Language, Speech, and Hearing Services in Schools, 37(1), 50-60.
 Beukelman, D. R., & Mirenda, P. (2005). Augmentative & alternative communication: Supporting children & adults with complex communication
needs. Baltimore: Paul H. Brookes Pub.
 American Speech-Language-Hearing Association. (2004). Admission/discharge criteria in speech-language pathology [Guidelines]. Available
from www.asha.org/policy.
 American Speech-Language-Hearing Association. (2010). Roles and responsibilities of speech-language pathologists in schools [Professional
Issues Statement]. Available from www.asha.org/policy.
 Costigan, F. A., & Light, J. (2010). A review of preservice training in augmentative and alternative communication for speech-language
pathologists, special education teachers, and occupational therapists.Assistive Technology®, 22(4), 200-212.
 Ratcliff, A., Koul, R., & Lloyd, L. L. (2008). Preparation in augmentative and alternative communication: An update for speech-language
pathology training. American Journal of Speech-Language Pathology, 17(1), 48-59.
Koller & Soper 2016